RAM PTON HOSPITAL: BOYNTON REPORT

My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Social Services. The Statement is as follows:

"Following the showing of a programme on Yorkshire TV on 22nd May 1979, I invited Sir John Boynton to lead a team to review the management of Rampton Special Hospital. I am today publishing the team's very thorough report. Sir John and his fellow members had a most difficult task and I am deeply grateful to them for the work they have done.

"The report praised both the dedication and the hard work of most staff at the hospital, and many of the facilities there. I endorse this praise. But the team was also critical of the way the hospital is managed and called for major improvements in the treatment and care of patients. Altogether there are 205 recommendations and suggestions. Some of the main proposals were discussed by the team with staff at the hospital, and I can tell the House that some changes are already being made by the hospital, including much-needed changes on the male block wards.

"I accept the team's analysis of the hospital's and the department's shortcomings and the main thrust of the reforms they propose. They conclude that Rampton should continue to
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operate as a special hospital. I agree. I also accept their proposal that for the next three years Rampton should be supervised by a local board to be called the Rampton Review Board. This board will guide and support local management in securing the implementation of the changes which the team have proposed. The necessary order and regulations to establish the board as a special health authority will be made as soon as possible.

"I expect to announce soon the composition of the board; I hope it will be able to begin its work by the turn of the year.

"In addition, I have accepted the team's proposals for a reform of local management and for the appointment of a Medical Director who would provide the leadership for the hospital which has been lacking. I shall be advertising for the post of Medical Director very shortly.

"Another of the review team's main recommendations to which I attach great importance concerns the transfer of those patients at Rampton who have been waiting, some of them for a very long time, for places in local hospitals. I share the team's concern on this difficult issue and I am writing personally to all regional health authority chairmen about it, urging them to make swifter progress.

"Some of the recommendations by the team extend beyond Rampton and will require wider consideration. In particular, they propose a body to inspect and monitor all institutions where patients are detained under the Mental Health Act. This proposal has already been put to me in relation to legislation to amend the Mental Health Act. Sound and effective monitoring
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systems are essential to the proper running of all health services in this country, including those institutions which hold Mental Health Act patients. I am now considering the various ways in which this requirement can be met.

"In the interim, three of the four special hospitals will have schemes to involve in their work people from outside the hospital; Rampton will have its review board; at Moss Side and Park Lane Hospitals the local community health council has, as the House already knows, arranged to make regular visits. I am urgently considering how a similar arrangement could be made at Broadmoor.

"Change cannot be achieved overnight. Implementation of the review team's recommendations requires changes in attitudes as well as staff and financial resources. The team noted that management and staff appear to accept the need to examine traditional attitudes, practices and régimes, and we must seek to ensure that through the Boynton Report a much stronger impetus is given to the improved running of the hospital and higher standards of patient care. To achieve this, the hospital will need the full understanding and support of all of us—the professions, the public and Parliament. The patients for whom we care deserve no less."

My Lords, the first thing I should like to do in thanking the noble Baroness the Minister for repeating the Statement made by her right honourable friend in another place is to associate my colleagues on this side of the House in the congratulations to Sir John Boynton and his team on producing what I think is a very important report. I say "I think", because I have only recently—within the last two hours—received a copy of the report, and, as the noble Baroness has said, there are something like 205 recommendations and suggestions. It is a document about a matter which has been a cause of concern to a number of members of your Lordships' House for some years now, and, because it is a report on Rampton, it is an important one.

We shall want to study the report carefully, particularly that part which argues for the retention of the hospital.
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I am sorry that the Secretary of State has already made up his mind that Rampton shall continue to operate as a special hospital, and I hope he will not be opposed to receiving suggestions which may be to the contrary.

What we hope most of all is that the report will provide a solution to the problems known to exist at Rampton at the present moment, and we on this side of the House are mindful, as I am sure is every noble Lord in your Lordships' House, of the fact that there are, and have been for some considerable time, difficulties which have got to be overcome in, I would say, the immediate future.

I should like to ask the noble Baroness whether she can indicate whether the Secretary of State will make available extra finance to implement some of the recommendations and suggestions which appear to be quite urgent. I am glad he has indicated, even if only by implication, that action will be taken quickly in the matter, because the report of the Elliot Committee of 1973, which was set up to deal with industrial relations at Rampton, has in fact not been implemented in any way. I do not attach blame to the present Government for that, but it would be a disaster, if I may say so, if this report were to be treated in much the same way as the Elliot Report.

I would also ask the noble Baroness whether the Secretary of State agrees that it is necessary to strengthen the professional leadership. I notice from the report that there is going to be the appointment of a medical director; but I think it is necessary to look at this matter in detail, because I think it is not only a question of having a medical director but one of seeing that certain other people who are in responsible positions give the kind of leadership that is necessary. I should also like to ask the noble Baroness to suggest to her right honourable friend the Secretary of State that one of the urgent things to be done is the improvement of industrial relations, which, I was going to say, exist, but which, rather, do not exist at Rampton at the present moment. I have in mind the fact—at least, I have been given to understand this—that the Department of Health and Social Services arranged for the visit of a journalist to Rampton as recently as last Friday, and that when the party arrived
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they were refused by the staff. To all of us in your Lordships' House, I think, it is most undesirable that this kind of thing should happen, and I hope the Secretary of State will pay particular attention to industrial relations.

Bearing in mind that Rampton Hospital is isolated, I wonder whether the Secretary of State has any views with regard to the geographical situation. I know the Statement of the Secretary of State says that he agrees it should continue to operate as a special hospital, but I hope he will not be inflexible about that. My final comment concerns the next paragraph, which says:
I also accept their proposal that for the next three years Rampton should be supervised by a local board".
I am wondering what "local" means. I think it is a great pity if the board is going to be made up solely of local people. It is a highly-specialised hospital, presenting difficulties peculiar to that kind of hospital, and I would suggest, with respect, that the board ought to be drawn from a wide field of people who can bring (shall I say?) a good deal of confidence and expertise, and that it should not just be kept as a local board. Perhaps I have put the wrong interpretation on the word "local".

My Lords, on behalf of my noble friends on these Benches, I, too, should like to thank the noble Baroness, Lady Young, for repeating this very important Statement made in another place; and we, too, would wish to join with the noble Baroness and with the noble Lord, Lord Wells-Pestell, in paying a tribute to Sir John Boynton and his colleagues for their truly remarkable work. The noble Baroness agreed that this has not been a committee which has sat in a committee room perusing papers: it has been a body which has more or less taken up residence in Rampton, has wandered about at all times of the day and night, often unannounced, and has acquired a very full knowledge and understanding of what goes on at Rampton—and for that, I think, noble Lords in all parts of the House should be very grateful indeed to Sir John Boynton and his colleagues. Perhaps the noble Baroness would agree that we might also
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pay a tribute to Yorkshire Television, without whose intervention it might be that this very important review would not have been held at all.

As the noble Baroness has said, there are 205 recommendations. Perhaps I might ask the noble Baroness to note that my noble friends and I would wish to applaud Recommendation 203, which states:
Less emphasis can and should be placed at Rampton on the provisions of the Official Secrets Act";
and perhaps also the associated sentence in the body of the report, at 5.12:
We think that Rampton operates too much as a closed and secretive institution".
I would ask the noble Baroness whether she agrees. But if, as a result of this report and the action which the Government are taking—and I welcome that action, which has been taken so rapidly—this leads to institutions like Rampton being opened up to public scrutiny on a continuing basis, I am sure the noble Baroness would agree that this could only be for the benefit of patients, staff and the public as a whole.

There is one final point I should like to raise with the noble Baroness. She will have noted that the report refers to overcrowding, and makes certain recommendations with regard to it. Does the noble Baroness recollect that it is now 6½, years since the Committee on Mentally Abnormal Offenders, under the chairmanship of the noble Lord, Lord Butler, made an interim report asking urgently for the setting up of regional, secure units of something like 2,000 beds? If, as I understand is the case, very little progress has been made with regard to that, does the noble Baroness agree that progress on that front would itself do a very great deal to implement the recommendations of this important report?

My Lords, may I intervene for one moment? I have not had an opportunity to read the report, so I cannot comment on it, but I should like to ask the noble Baroness whether she would say one other thing which follows on directly from what the noble Lord, Lord Winstanley, has said. As your Lordships know, we have recently been debating the Broadcasting Bill, during which there has
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been savage criticism of television for portraying violence and generally lowering the moral tone of the nation. I have a deep family interest in this because I am rather proud of the fact that it was my son who directed and produced the programme which led to this report. I should like to ask the noble Baroness whether she would concur with what the noble Lord, Lord Winstanley, has said, and agree that, sometimes, television in this country can do a great deal of good.

My Lords, I should like to thank both the noble Lord, Lord Wells-Pestell, and the noble Lord, Lord Winstanley, for welcoming this report, and particularly for their congratulations to Sir John Boynton, in which I think we all share. In answer to the questions, the noble Lord, Lord Wells-Pestell, asked quite particularly about finance. Perhaps I could say that it is not proposed that there will be any addition to total public expenditure arising from this report, but the Secretary of State will be considering whether he can find savings from elsewhere. I think I should say that the review team pointed out that shortage of funds was not in fact an important factor in this matter.

On the question of the timing of doing something about it, as I have indicated, my right honourable friend the Secretary of State has accepted the principal recommendation that there should be a review board. This is to be set up, we hope, by the turn of the year, so we are getting on with this as quickly as possible, as is the case with the appointment of a medical director, which we believe will strengthen the professional leadership in the hospital and thus, again, meet one of the major criticisms of the inquiry team; because the inquiry showed that what we need to get right is the management structure, and that a lead is needed to pull the management structure together and, indeed, to implement the recommendations. I hope that that will meet the point that the noble Lord, Lord Wells-Pestell, made about strengthening the professional leadership and, in that connection, of course, improving industrial relations. On his last point about the local board, perhaps I could say that, of course, this is the Rampton Review Board, which we hope will be set up by the turn
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of the year, and of course it would include professional people. We need to have people of a wide understanding of these particular matters.

Again, the noble Lord, Lord Winstanley, asked whether or not we recognised that Rampton Hospital had been "closed and secretive"—I think those were the words he used. The acceptance of the principal recommendation of the Boynton Committee—namely, that there should be a review board with responsibility—will, I think, go some way towards meeting this point. He also asked a specific point about overcrowding in the hospital. He might like to know that the hospital has a bed complement of approximately 1,000 beds, and there are currently 816 patients, so I do not think one can say that there is any overcrowding.

On the other point which the noble Lord made and which went rather wider than the report, perhaps I might write him. The noble Lord, Lord Willis, intervened to say what I think the noble Lord, Lord Winstanley, was also saying regarding our recognition of Yorkshire Television's achievement in bringing this matter to our notice. It would be right to say that we all recognise the important part that the media can play in this connection and we all hope that where we have responsible reporting, whenever it may come about, this is of value to all the services.

My Lords, as one who has visited Broadmoor many times over the years may I ask whether the noble Baroness would be able to say anything about the bearing of all this on Broadmoor? Some of us admire enormously what Dr. McGrath, for example, has done at Broadmoor but there have been many criticisms. What is the bearing of this on Broadmoor?

My Lords, the Statement is concerned with the Boynton Report on Rampton but, as I said at the end of the Statement, my right honourable friend the Secretary of State hopes that we shall be able to involve people from outside in the work of the four special hospitals of which Broadmoor is one. There will be the review board in the case of Rampton and, in the case of Moss Side and Park Lane, there will
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be the local community health council. We are urgently looking at similar arrangements that could be made at Broadmoor.

My Lords, anybody who has had experience of mental hospitals—and I recognise that these are special hospitals—will welcome this report even though, like me, many have not yet had a chance of seeing it. Would my noble friend accept that the chief nursing officer at Rampton and the devoted staff behind him have been sniped at in a most irresponsible way on many occasions? In view of the dangerous job that they do, this report will be most welcome. Can my noble friend comment on a report which appeared in the press that the chief nursing officer has been criticised by the Prison Officers' Association on some grounds or another which were not made clear? In view of the very difficult task he has to perform and the generous tribute that he paid to his nursing staff, is this not a very unfortunate state of affairs? Finally, may I ask my noble friend whether it is not desirable that, since the Rampton Hospital is very much the concern of local people, as many local people as possible should be concerned with this inquiry?

My Lords, I am grateful to my noble friend Lord Auckland for what he has said about the staffing problem. We all recognise that they have a difficult job to do and I am sure that it would be the wish of the whole House that we should recognise this. None the less, we must recognise the public anxiety caused by the revelations of the television programme. On his last point, I do not wish to comment on what may have appeared in the press.